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Agents of skin-manifested infections · Francisella tularensis (cats) & many others. Other injuries...
Transcript of Agents of skin-manifested infections · Francisella tularensis (cats) & many others. Other injuries...
InstituteInstitute forfor Microbiology, Medical Faculty of Masaryk University Microbiology, Medical Faculty of Masaryk University
and St. Anna Faculty Hospitaland St. Anna Faculty Hospital in Brnoin Brno
Miroslav VotavaMiroslav Votava
Agents of Agents of skinskin--manifested manifested infectionsinfections
Lecture for 3rdLecture for 3rd--year studentsyear students
2nd2nd DecemberDecember, 20, 201111
Common superficial injuriesCommon superficial injuries
–– revision revision
•• StaphylococcusStaphylococcus aureusaureus
•• StreptococcusStreptococcus pyogenespyogenes
•• betabeta--hemolytic streptococci of other hemolytic streptococci of other
groups (above all G, F, C)groups (above all G, F, C)
! Attention in case of ! Attention in case of aa foreign body in the foreign body in the
wound (splinter, thorn) and in case of wound (splinter, thorn) and in case of
deeper stab wounds (fork soiled by deeper stab wounds (fork soiled by
horse manure): horse manure): ClostridiumClostridium tetanitetani
Severe contused woundsSevere contused wounds –– revision revision
•• Agents of clostridial myonecrosis Agents of clostridial myonecrosis ((mostly mostly
Clostridium perfringens, C. septicum, C. Clostridium perfringens, C. septicum, C.
novyi, C. histolyticum)novyi, C. histolyticum)
clostridial myonecrosis = anaerobic clostridial myonecrosis = anaerobic
traumatosis = traumatosis = gas gangrenegas gangrene oror malignant malignant
edemaedema
•• ClostridiumClostridium tetanitetani
•• Staph. aureus, Strept. pyogenes Staph. aureus, Strept. pyogenes && other other
pyogenic bacteriapyogenic bacteria
Wounds sustained in waterWounds sustained in water
–– revision revision
•• In In freshfresh water:water:
Pseudomonas aeruginosaPseudomonas aeruginosa
Aeromonas hydrophilaAeromonas hydrophila
otherother pseudomonads and aeromonadspseudomonads and aeromonads
•• In In saltsalt water:water:
Vibrio parahaemolyticus, V. vulnificusVibrio parahaemolyticus, V. vulnificus
Mycobacterium marinum Mycobacterium marinum (also in fresh(also in fresh--water water swimming pools, tanks and aquaria)swimming pools, tanks and aquaria)
Injuries sustained in the tropicsInjuries sustained in the tropics
–– revisionrevision
Mainly on feetMainly on feet
•• soil nocardiae soil nocardiae ((Dermatophilus Dermatophilus
congolensis, Rhodococcus equicongolensis, Rhodococcus equi))
•• atypical mycobacteria atypical mycobacteria ((Mycobacterium Mycobacterium
ulcerans, Mycobacterium haemophilumulcerans, Mycobacterium haemophilum))
•• micromycetes micromycetes ((Sporothrix schenckii, Sporothrix schenckii,
Paracoccidioides brasiliensisParacoccidioides brasiliensis))
Surgical woundsSurgical wounds –– revision revision
Staphylococcus aureusStaphylococcus aureus
coagulasecoagulase--negative staphylococci negative staphylococci (mainly (mainly Staphylococcus epidermidisStaphylococcus epidermidis))
EnterobacteriaceaeEnterobacteriaceae ((Escherichia coli, Escherichia coli, Proteus mirabilisProteus mirabilis))
Streptococcus pyogenesStreptococcus pyogenes
anaerobes (anaerobes (Peptostreptococcus micros, Peptostreptococcus micros, Peptostreptococcus anaerobius, Peptostreptococcus anaerobius, Bacteroides fragilisBacteroides fragilis))
BurnsBurns –– revision revision
Almost everything, but Almost everything, but predominantlypredominantly::
Pseudomonas aeruginosaPseudomonas aeruginosa
Staphylococcus aureusStaphylococcus aureus
Streptococcus pyogenesStreptococcus pyogenes
other streptococciother streptococci
enterococcienterococci
candidae and aspergillicandidae and aspergilli
MManan--inflicted inflicted bbitesites –– revision revision
members of oral microfloramembers of oral microflora
-- „oral streptococci“ („oral streptococci“ (Streptococcus Streptococcus
sanguinis, S. oralis, S. anginosussanguinis, S. oralis, S. anginosus) )
-- anaerobes (anaerobes (Fusobacterium nucleatum Fusobacterium nucleatum
ssp. ssp. nucleatum, Porphyromonas nucleatum, Porphyromonas
gingivalisgingivalis) )
Staphylococcus aureusStaphylococcus aureus
Animal bitesAnimal bites –– revision revision
Most often: Most often:
Pasteurella multocida Pasteurella multocida (cats, dogs)(cats, dogs)
Less often:Less often:
Staphylococcus aureusStaphylococcus aureus (any animal)(any animal)
Capnocytophaga canimorsus Capnocytophaga canimorsus (dogs)(dogs)
Streptobacillus moniliformis Streptobacillus moniliformis (rats)(rats)
Spirillum minus Spirillum minus (mice, rats, cats, dogs)(mice, rats, cats, dogs)
Francisella tularensisFrancisella tularensis (cats)(cats)
&& many othersmany others
Other injuries by animalsOther injuries by animals –– revision revision
Francisella tularensis Francisella tularensis (rodents, hares (rodents, hares –– tularemia)tularemia)
Bartonella henselae Bartonella henselae (cat scratch disease)(cat scratch disease)
Erysipelothrix rhusiopathiae Erysipelothrix rhusiopathiae (pigs, carps (pigs, carps –– erysipeloid)erysipeloid)
Bacillus anthracis Bacillus anthracis (herbivores (herbivores –– skin skin anthrax, pustula maligna)anthrax, pustula maligna)
Burkholderia mallei Burkholderia mallei (horses, donkeys (horses, donkeys –– glanders, malleus)glanders, malleus)
……
Infections with skin symptomsInfections with skin symptoms
1.1. primaryprimary skin infectionsskin infections
2.2. secondarysecondary infections of already infections of already
diseased skindiseased skin
3.3. skin symptoms skin symptoms of systemic infectionsof systemic infections
EtiologyEtiology: bacterial: bacterial
viralviral
fungalfungal
parasiticparasitic
Primary Primary acute bacterialacute bacterial skin skin
infections infections –– II
acne vulgaris acne vulgaris –– Propionibacterium acnesPropionibacterium acnes
carbunculuscarbunculus nuchaenuchae –– Staph. aureusStaph. aureus
ecthymaecthyma gangraenosumgangraenosum –– Ps. aeruginosaPs. aeruginosa
erysipelaserysipelas –– Streptococcus pyogenesStreptococcus pyogenes
erysipeloiderysipeloid –– ErysipelothrixErysipelothrix
erythrasmaerythrasma –– Corynebact. MinutissimumCorynebact. Minutissimum
folliculitisfolliculitis –– Staph. aureus, P. aeruginosaStaph. aureus, P. aeruginosa
furunculosisfurunculosis (boil) (boil) –– StaphStaph.. aureusaureus
Primary Primary acute bacterialacute bacterial skin skin
infections infections –– IIII
hidradenitishidradenitis suppurativasuppurativa –– Staph. aureusStaph. aureus
hordeolum hordeolum ((styestye) ) –– Staph. aureusStaph. aureus
impetigoimpetigo –– Staph. aureus, Str. pyogenesStaph. aureus, Str. pyogenes
lymphangoitislymphangoitis –– StreptStreptococcusococcus pyogenespyogenes
panaritiumpanaritium –– StaphStaphylococcusylococcus aureusaureus
paronychiumparonychium –– Staphylococcus aureusStaphylococcus aureus
sycosissycosis barbaebarbae –– Staphylococcus aureus Staphylococcus aureus
Primary Primary chronic bacterialchronic bacterial skin skin
infections infections
actinomycosisactinomycosis –– Actinomyces israeliiActinomyces israelii
chronicchronic subcutaneous abscessessubcutaneous abscesses –– AActinctin. . israelii, Nocardia asteroides, israelii, Nocardia asteroides, Rhodococcus equiRhodococcus equi
skinskin granulomasgranulomas –– Mycobacterium Mycobacterium marinum, M. haemophilum, M. chelonaemarinum, M. haemophilum, M. chelonae
leprosyleprosy –– Mycobacterium lepraeMycobacterium leprae
lupuslupus vulgarisvulgaris –– Mycob. tuberculosisMycob. tuberculosis
scrophulodermascrophuloderma –– M. tuberculosis, M. bovisM. tuberculosis, M. bovis
SecondarySecondary infections of skin lesionsinfections of skin lesions
decubitus decubitus (bedsore), (bedsore), trophic ulcer trophic ulcer –– neighbouringneighbouring
and endogenous flora (staphylococci, and endogenous flora (staphylococci,
streptococci, enterococci, enteric bacteria, streptococci, enterococci, enteric bacteria,
pseudomonads and other Grampseudomonads and other Gram--negative nonnegative non--
fermenting rods, anaerobes, yeasts)fermenting rods, anaerobes, yeasts)
infected atheroma infected atheroma –– S. aureus, PS. aureus, Propionropion. acnes. acnes
infected intertrigo infected intertrigo (raw) (raw) –– S. aureus, P. acnesS. aureus, P. acnes
sec. infected dermatomycoses sec. infected dermatomycoses –– S. pyogenesS. pyogenes
infected wounds infected wounds –– discussed in previous lecturediscussed in previous lecture
Skin symptoms of Skin symptoms of systemicsystemic bacterial bacterial
infectionsinfections
roseola roseola (rash in typhoid fever)(rash in typhoid fever) –– Salmonella Salmonella TyphiTyphi
disseminated gonorrhoeadisseminated gonorrhoea –– Neisseria gonorrhoeaeNeisseria gonorrhoeae
erythemaerythema migransmigrans –– Borrelia burgdorferiBorrelia burgdorferi
infectiveinfective endocarditisendocarditis –– willwill be debe deaalt with by sepsislt with by sepsis
meningococcemiameningococcemia –– Neisseria meningitidisNeisseria meningitidis
scarlatinascarlatina (scarlet fever) (scarlet fever) –– Streptococcus pyogenesStreptococcus pyogenes
SSSSSSSS (staphylococcal scalded skin syndrome) (staphylococcal scalded skin syndrome) –– Staphylococcus aureusStaphylococcus aureus
toxic shock syndrometoxic shock syndrome –– S. aureus, S. pyogenesS. aureus, S. pyogenes
syphilissyphilis –– Treponema pallidumTreponema pallidum
Etiology of skin Etiology of skin fungalfungal infectionsinfections
Etiology differs inEtiology differs in
•• superficialsuperficial mycosesmycoses, like , like pityriasispityriasis versicolorversicolor
–– Malassezia furfur Malassezia furfur ((prevprev. . Pityrosporum ovalePityrosporum ovale))
•• mucocutaneousmucocutaneous mycosesmycoses –– Candida albicans Candida albicans
and other species of candidaeand other species of candidae
•• cutaneouscutaneous mycosesmycoses –– typical dermatophytestypical dermatophytes
•• subcutaneoussubcutaneous mycosesmycoses
•• opportuneopportune skin mycosesskin mycoses in immunodeficiin immunodeficitestes
Etiology of Etiology of cutaneous mycosescutaneous mycoses –– II
Three genera Three genera of dermatophytes:of dermatophytes:
1.1. TrichophytonTrichophyton
e.g. e.g. Trichophyton rubrumTrichophyton rubrum
2.2. MicrosporumMicrosporum
e.g.e.g. Microsporum canisMicrosporum canis
3.3. EpidermophytonEpidermophyton
only only Epidermophyton floccosumEpidermophyton floccosum
Etiology of Etiology of cutaneous mycosescutaneous mycoses –– IIII
tinea pedis tinea pedis –– Trichophyton rubrumTrichophyton rubrum, Trich. , Trich. mentagrophytes mentagrophytes var. var. interdigitale, interdigitale, Epidermophyton floccosumEpidermophyton floccosum
onychomycosis onychomycosis –– T. rubrum, E. floccosumT. rubrum, E. floccosum
tinea corporis tinea corporis –– T. rubrum, Microsporum canis, M. T. rubrum, Microsporum canis, M. gypseum, T. mentagrophytes gypseum, T. mentagrophytes var. var. mentagrophytes, E. floccosummentagrophytes, E. floccosum
tinea capitistinea capitis, type , type ectothrixectothrix –– M. gypseum, M. M. gypseum, M. canis, M. audouinii, T. mentagrophytes canis, M. audouinii, T. mentagrophytes var. var. mentagrophytes, T. verrucosummentagrophytes, T. verrucosum
typetype endothrixendothrix –– T. tonsuransT. tonsurans
favus favus –– Trichophyton schoenleiniiTrichophyton schoenleinii
Etiology of Etiology of subcutaneous mycosessubcutaneous mycoses
pheohyphomycosis pheohyphomycosis (lesions with pigmented (lesions with pigmented hyphae) hyphae) –– genera genera Alternaria, Aureobasidium, Alternaria, Aureobasidium, Cladosporium, Culvularia, Cladosporium, Culvularia, ExophialaExophiala, , Phaeoannelomyces, Phoma, Wangiella Phaeoannelomyces, Phoma, Wangiella & others& others
chromoblastomycosis chromoblastomycosis (warty nodules with sclerotic (warty nodules with sclerotic bodies) bodies) –– Cladophialophora, Cladophialophora, FonsecaeaFonsecaea, , Phialophora Phialophora
mycetoma eumycoticum mycetoma eumycoticum (swollen lesion with (swollen lesion with draining tracts draining tracts containingcontaining small grains) small grains) –– Acremonium, Exophiala, Madurella, Acremonium, Exophiala, Madurella, PseudoallescheriaPseudoallescheria (= Scedosporium)(= Scedosporium)
sporotrichosis sporotrichosis (dimorphic fungus) (dimorphic fungus) –– SporothrixSporothrix schenckiischenckii
Etiology of Etiology of opportune skin mycosesopportune skin mycoses
in immunodeficitesin immunodeficites
Fusarium Fusarium solani, Fusarium oxysporum, solani, Fusarium oxysporum,
Fusarium verticillioidesFusarium verticillioides
PseudoallescheriaPseudoallescheria boydiiboydii (= (= teleomorf, teleomorf,
sexual phase of anamorfsexual phase of anamorf Scedosporium Scedosporium
apiospermum)apiospermum)
PenicilliumPenicillium marneffei marneffei (systemic infection (systemic infection
with skin manifestations)with skin manifestations)
ScopulariopsisScopulariopsis brevicaulisbrevicaulis
Skin symptoms in Skin symptoms in viralviral diseases diseases –– I I
MacularMacular (spotted) exanthem:(spotted) exanthem:
morbillimorbilli –– morbilli virus (morbilli virus (Morbillivirus Morbillivirus genus)genus)
rubellarubella –– rubella virus (rubella virus (RubivirusRubivirus genus) genus)
erythemaerythema infectiosuminfectiosum (the fifth disease) (the fifth disease) ––
parvovirus B19 (parvovirus B19 (Erythrovirus Erythrovirus genus) genus)
exanthemaexanthema subitumsubitum (roseola infantum, the sixth (roseola infantum, the sixth
disease) disease) –– HHV 6 (HHV 6 (Roseolovirus Roseolovirus genus)genus)
Umbiliform Umbiliform papulaepapulae::
molluscummolluscum contagiosumcontagiosum –– molluscum molluscum
contagiosum virus (contagiosum virus (Molluscipoxvirus Molluscipoxvirus genus) genus)
Skin symptoms in Skin symptoms in viralviral diseases diseases –– II II
VesiclesVesicles::
herpesherpes simplexsimplex (cold sore) (cold sore) –– HSV 1 HSV 1 ((Simplexvirus Simplexvirus genusgenus))
herpesherpes genitalisgenitalis –– HSV 2 HSV 2 ((Simplexvirus Simplexvirus genusgenus))
varicellavaricella (chicken pox) (chicken pox) –– varicellavaricella--zoster virus zoster virus ((VZV, VZV, Varicellovirus Varicellovirus genusgenus))
herpesherpes zosterzoster (shingles) (shingles) –– varicellavaricella--zoster zoster virus virus ((VZV, VZV, Varicellovirus Varicellovirus genusgenus))
variolavariola veravera (smallpox) (smallpox) –– variola virus variola virus ((Orthopoxvirus Orthopoxvirus genusgenus)) (continued)(continued)
Skin symptoms in Skin symptoms in viralviral diseases diseases –– III III
VesiclesVesicles –– cont.:cont.:
vacciniavaccinia –– vaccinia virus vaccinia virus ((Orthopoxvirus Orthopoxvirus genusgenus))
cowpox and monkey poxcowpox and monkey pox –– cowpox virus and cowpox virus and monkey pox virus monkey pox virus ((Orthopoxvirus Orthopoxvirus genusgenus))
tubera mulgentiumtubera mulgentium (milkers(milkers´́ nodules) nodules) –– milkermilker´́s s nodule virus nodule virus ((Parapoxvirus Parapoxvirus genusgenus))
aphthae epizooticaeaphthae epizooticae (foot and mouth disease) (foot and mouth disease) –– footfoot--andand--mouth disease virusmouth disease virus (FMDV,(FMDV, Aphthovirus Aphthovirus genusgenus))
hand, foot and mouth diseasehand, foot and mouth disease –– coxsackievirus coxsackievirus A16 A16 ((EnterovirusEnterovirus genusgenus))
Skin symptoms in Skin symptoms in viralviral diseases diseases –– IV IV
PetechiaePetechiae::
Hemorrhagic feversHemorrhagic fevers ––
Ebola feverEbola fever, Ebola virus , Ebola virus ((Ebolavirus Ebolavirus genusgenus))
Marburg diseaseMarburg disease, Marburg virus , Marburg virus ((Marburgvirus Marburgvirus genusgenus))
Lassa feverLassa fever, Lassa virus , Lassa virus ((Arenavirus Arenavirus genusgenus))
GeneralizedGeneralized congenitalcongenital cytomegalic diseasecytomegalic disease ––
cytomegalovirus cytomegalovirus ((CMV, CMV, Cytomegalovirus Cytomegalovirus genusgenus))
Skin symptoms in Skin symptoms in parasitosesparasitoses –– II
DomesticDomestic (native) parasitoses:(native) parasitoses:
scabiesscabies –– itch mite (itch mite (Sarcoptes scabieiSarcoptes scabiei))
demodicosis demodicosis –– human follicle mites (members of human follicle mites (members of
Demodex Demodex genus)genus)
pediculosis capitispediculosis capitis –– head louse (head louse (Pediculus Pediculus
capitiscapitis))
pediculosis corporispediculosis corporis –– body louse (body louse (Pediculus Pediculus
humanushumanus, syn. , syn. Pediculus corporisPediculus corporis))
pediculosis pubispediculosis pubis (phthiriasis) (phthiriasis) –– pubic (crab) pubic (crab)
louse louse ((Phthirus pubisPhthirus pubis))
Skin symptoms in parasitoses Skin symptoms in parasitoses –– IIII
Infestation by native Infestation by native ectoparasitesectoparasites::
cimicosiscimicosis, urticaria cimicosa , urticaria cimicosa –– bites by bedbug bites by bedbug Cimex lectulariusCimex lectularius
pulicosispulicosis –– bites by human flea bites by human flea Pulex irritans,Pulex irritans, dog flea dog flea Ctenocephalides canisCtenocephalides canis, , cat flea cat flea Ctenocephalides felisCtenocephalides felis, , chicken flea chicken flea Ceratophyllus gallinaeCeratophyllus gallinae
ixodosisixodosis –– bitebite by hard tick by hard tick Ixodes ricinusIxodes ricinus
culicosisculicosis –– bites by common mosquito bites by common mosquito Culex Culex pipienspipiens
trombiculosistrombiculosis, trombidiosis , trombidiosis –– bitesbites by by Neotrombicula autumnalisNeotrombicula autumnalis larvaelarvae
Skin symptoms in parasitoses Skin symptoms in parasitoses –– IIIIII
TropicalTropical parasitoses:parasitoses:
ulcus humidum ulcus humidum (humid ulcer) (humid ulcer) –– Leishmania majorLeishmania major
ulcus siccum ulcus siccum (dry ulcer) (dry ulcer) –– Leishmania tropicaLeishmania tropica
espundiaespundia –– Leishmania braziliensisLeishmania braziliensis
tungosistungosis –– chigoe flea chigoe flea Tunga penetransTunga penetrans
dermatitis cercariosadermatitis cercariosa –– cercariae of cercariae of Schistosoma, Schistosoma,
Bilharziella Bilharziella andandTrichobilharziaTrichobilharzia generagenera
dracunculosisdracunculosis –– Dracunculus medinensisDracunculus medinensis
filariosisfilariosis –– filariae filariae Loa loa Loa loa and and Onchocerca Onchocerca
volvulusvolvulus
……
Homework Homework
99
Jan Havickzoon Jan Havickzoon
SteenSteen (1626(1626--1679):1679):
The Sick Woman The Sick Woman
(c. 1665)(c. 1665)
HomeworkHomework 99 Another two pictures byAnother two pictures by Jan Havickzoon SteenJan Havickzoon Steen (1626(1626--1679) 1679)
on the similar topic:on the similar topic:
The Lovesick Woman (1960) The DoctorThe Lovesick Woman (1960) The Doctor´́s Visit (1960s Visit (1960--63)63)
Homework Homework 99
Successful homework 9 solvers:Successful homework 9 solvers:
Mohammed Imran SajidMohammed Imran Sajid
Bárbara RaimundoBárbara Raimundo
Veronika SykorovaVeronika Sykorova
Mavis Araba KoufieMavis Araba Koufie
Congratulations!Congratulations!
Homework Homework
1010
Please give the name Please give the name
of the author and of of the author and of
the paintingthe painting
Answer and questionsAnswer and questions
The solution of the homework and possible The solution of the homework and possible
questions please mail to the addressquestions please mail to the address
[email protected]@med.muni.cz
Thank you for your attentionThank you for your attention